HomeMy WebLinkAboutBLD1989-00065 •
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Jefferson County Planning and Rui ldina Department
Courthouse , 3rd Floor
PO Rox 1220
Port Townsend, WA gR36S
206-3R5-y 1 4 1
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STTF Af1iRFSS : 1 OA S CHANilT,F.R CT
-PORT mUOT,Ow, WA SS3f 5
{)WN R • POPE. RFSOURCRS PHONE!
ATT,TNC AI)fR : 70 RRF,AKFR VANE
PORT T.T1flT,OW WA a5365
::ONTRACTOR . . :NO CONTRACTOR PRONE!
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CONTR . T,T C #! RXPTRAT T ON T)ATF.:
PARCFT. NO. _ . : S21 1 7
F.CAT, ilRSC. . : S T-R WM, TAX #
T.OT BLOCK
w SCR T P TTON OF TMPROVFMFNT
Fontinn/Sethacks (Shoreline Sethack) /Mohile Home Riockincr:
i Foundation !
Underground Plumbing/Underground Tnsuiatinn :
Framing:/Plum in /Chimney:
i Tnsulation : 24.
i Sheetrnck / .._ g/YC
1 Sewage Disposal System Final :
( ) Final /Occunancv Approval
f24'ft
(AT,T. 385-91 4 1 24 HOURS TN ADVANCF TO SC H DUT,F TNSPFCT T ONS .
Office Hours 9 a .m . to 5 p.m.
inspector ' s Hours 9 - 10 a . m.
24 Hour Recorder for inspections.
(3UILr)O.3 'ERMIT APPLICATION tili)Iec PIN I It....A
Jefferson County Building DepartmentSP .O . Box 1220'Port Townsend. WA 98368'
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LOCATION
tri-in ry1 a hrl,f er .C�s -t .SPECIFIC LOCATION SITE ADDRESS �)
POSTAL DISTRICT /SUBDIVISION 11PV' f t1 Y' v1 l e
LEGAL DESCRIPTION LO'1fi1- 8 BLOCK( DIVISION TAX NUMBER
PARCEL NUMBER 7t,rJ I1 - �y 1 / 4 SECTION
PLANNING AREA SECTION /7 TOWNSHIP p.c N NORTH RANGE 1 i WI'1
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE -�
❑ SINGLE FAMILY XNEW BUILDING MAIN FLOOR _ 1.f /_.ci
❑ MOBILE HOME ❑ ADDITION 2ND FLOOR R11-..5a
❑ MODULAR HOME ❑ ALTERATION BASEMENT
N DETACHED/ATTACHED ❑ REPAIR CARPORT p '-/"." .�
GARAGE ❑ REPLACEMENT GARAGE [140. `Q
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
MULTI - FAMILY [] RELOCATION/MOVING INDUSTRIAL ,
NUMBER OF UNITS 2,
MOBILE HOMES ^^�� �j qI
❑ COMMERCIAL SIZE c,�3R a.{ @. $3 5 �3 i`2. 5Q
❑ INDUSTRIAL /5 . DO
YEAR $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE VJ a1 ;8
NUMBER OF UNITS 28L5.0
y if {,
❑ OTHER - SPECIFY ESTIMATED COST OF J8 J @ $_8� (0101/. 00
IMPROVEMENTS TOTAL FAIT MARKET VALUE
UBC OCCUPANCY GROUP $ /['.4(e; .,. --
12-/J
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAMEPRINCIPLE TYPE OF HEATING FUEL
X WOOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL 7Py�"(!1eitrati(1tt
❑ REINFORCED CONCRETE ❑ OIL KOTHER - SPECIFY —4ruof!apP
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES 2 TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS I
PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
❑ INDIVIDUAL 1 V i DUAL ( SEPTIC )1 C ) NUMBER OF PROPOSED BATHROOM (a
N �"
APPROVE RATE
❑ I ND I V I DUAL WELL NUMBER OF EXIST I NG BATHROOM �`
PUD TYPE OF WATER SUPPLY X PUBLIC '( NAME OF WATER SUPPLY) LU'QLOLL LL)a,�/V►
k
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES 0 NO
IDENTIFICATION
NAME M MAILING' ry�((\''��(/A��DDRESS (D�(,�,/j jI
ZIP TEL NO
OWNER [� C2 Q P U��,i�ii� ^'T"t�
�aaaiiiiLLLL at L �lSL F\►'I • 3�5 /37 gin 1
n CONT 1( R
eSnurr•SrA A. I CENSE O
ARCH
('HE OWNER OF THI ' BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
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OF / ` 1 ell__ APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
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,�J�//no 1��I. y PERT FEES
A P r (o(7(1 V LJ BASE FEE INSPECTION
AUGZ (4 BLDG SURCHARGE PLAN CHECK
Z �9eg ilS~g('V ENERGY SURCHARGE Q ( 5� TOTAL
JEFFERSON COUNTY P PLANNING S BLOG OEpr 9 1 1 NUMBER
REFUND DATE TE ISS
BUILDING OFFICIAL
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